6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare

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Editor’s Note: A version of this article was originally published in the June 2014 edition of HFM Magazine

Healthcare organizations routinely pursue performance improvement initiatives to improve clinical outcomes and patient experiences and reduce organizational costs. If these efforts are not well executed, however, they can become black holes that suck up time, money, and resources while yielding little in the way of real, sustainable improvements.

A major reason performance improvement efforts fail to produce desired results is that organizations often mistakenly think of performance improvement as a series of one-off projects, each with its own beginning, middle, and end. To be effective and sustainable, an organization’s performance improvement initiatives should all be conceived and performed in the context of an ongoing performance program.

The initial goals for such a program should be to prioritize performance improvement efforts so that the organization can achieve early successes and build momentum for future performance improvement efforts. Health Catalyst recommends a framework, known as the Three System Approach for performance improvement:

  • Improving measurement and analytics (an analytics system)
  • Creating permanent cross-functional workgroup teams focused on identifying, deploying and monitoring the effectiveness of quality improvements (an adoption system)
  • Deploying a data-driven approach to implementing evidence-based best practices (a best practice system)

Six Steps to Implementing a Performance Improvement Program

Step 1: Integrate Performance Improvement into Your Strategic Objectives

Healthcare is a complex, adaptive system where interactions and relationships of different components simultaneously affect and are shaped by the system. As such, it is important for performance improvement to be integrated within the healthcare organization’s strategic objectives. Strategic objectives such as becoming an accountable care organization (ACO), focusing on population health management, or developing a cardiovascular center of excellence, all require performance improvement in order to be successful. Integrating performance improvement also helps avoid wasting time, effort, and money on programs that may yield little overall benefit.

Step 2: Use Analytics to Unlock Data and Identify Areas of Opportunity

Performance improvement requires an analytics system that integrates the organization’s data sources (clinical, claims, financial, operational, etc.), and that facilitates quick and easy data sharing. Only with appropriate analytics can an organization identify specific areas of opportunity among strategic areas of focus.

Healthcare data analytics is required for any sustainable performance improvement initiative. It forms the foundation of discussion and informs decisions. Yet while healthcare organizations have mountains of clinical, claims, financial, operational, patient experience and other data, most of it is locked away in point solutions built for a specific purpose.

Performance improvement requires an analytic system that integrates the organization’s data sources, and quickly and easily unlocks data, and enables effective sharing of data and the addition of new data sources. Doing so allows interdisciplinary teams to analyze the data and discover patterns that lead to insights. This should be an Agile, interactive process that produces balanced metrics. Health Catalyst offers a unique solution with our Late-Binding™ Enterprise Data Warehouse.

The analytic system also needs to be able to scale over time to enable different levels of healthcare analytics. As an organization moves up the hierarchy of the Analytics Adoption Model (see Figure 1), data is used as an advantage and strength, helping the organization to compete more effectively.


Figure 1: Analytics Adoption Model

The starting point (Level 1) for sustainable performance improvement is an enterprise data warehouse (EDW) that can aggregate and store data from fragmented point solutions in one place and make it available to interdisciplinary teams.

Level 2 in the model is a standardized vocabulary and patient registries. Having a master vocabulary is critical for sharing data. Registries allow the organization to define the cohort of patients for a specific performance improvement program. The use of pre-defined patient registries and starter set measures to evaluate key metrics such as: financials, length of stay and readmissions provides a basis for initiating improvement projects.

Such was the experience of Texas Children’s Hospital in Houston. Before deploying an enterprise-wide late binding EDW and healthcare analytics, the hospital required roughly six months to develop a clinical improvement initiative. Having a healthcare EDW in place reduced this time in half because the data was available and already integrated across the different clinical, operational and financial systems. Implementing an analytics application that included patient

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